Detecting and stopping carious lesions in the early stages

There needs to be a paradigm shift in patient care: away from repair and towards health maintenance and regular monitoring.

Interview with Prof. Dr. Ivo Krejci in Dental Tribune, Swiss edition, No. 4/2022. Click here to read the original article in German online.

Detecting and stopping pathologies in the preclinical early stages.
Prof. Dr. lvo Krejci talks about the dentistry of the future.


As former President of the Dental Clinics of the University of Geneva, what key trends have you observed in the field of conservative treatments?
ln the past, the focus of conservative treatment was on repairing extensive dental damage, i.e. treating sick patients. ln recent times, the focus has increasingly shifted towards maintaining health. The aim is to detect and stop pathologies in their preclinical early stages in order to avoid clinically relevant symptoms such as cavitated caries lesions or advanced erosions and abrasions.

What key topics has scientific research in conservative dentistry dealt with in recent years?
The overriding issue has certainly been adhesion. In recent years, the focus has been on further optimizing dentin adhesion, the possibility of using one adhesive system for multiple substrates, and simplification. As a result of these efforts, we now have efficient single-component universal adhesives that can be used not only as pure bonding agents but also as penetrants in initial caries lesions.

Early caries diagnosis is close to your heart. How do you envisage this type of diagnostics being increasingly or even always performed?
There needs to be a paradigm shift in patient care: away from repair and toward health maintenance and regular monitoring.

What is the best way to do early diagnostics? How do you get the best results?
The example of caries is a good illustration of early diagnostics. Classic caries diagnostic methods such as manual probing or bitewing radiographs were developed for the detection of advanced lesions. They are not sensitive enough to detect the earliest enamel demineralizations and to reliably show the smallest changes in these demineralizations in terms of monitoring. The best early caries detection method from today’s point of view is infrared transillumination, ideally in combination with clinical macrophotography and fluorescence images. For the best results with this technology, the combined interpretation of the images is supported by artificial intelligence.

Are these new techniques already being seen in training programs and practices? If not, why not?
At the University of Geneva, infrared transillumination has been standard practice for many years, both in theoretical teaching and in the student clinic. The combination of this technology with clinical macroimaging and fluorescence imaging, as well as the Al-assisted interpretation of the images, has only recently become available. Therefore, they are not yet routine, but are currently being implemented into the workflow. For private practices, this new technology opens up new fields of activity that can generate many new patients.

Do you need special instruments for this treatment?
Yes, I have developed a new instrument kit with Deppeler, which has been reduced to an absolute minimum and is suitable for both non-invasive and classic adhesive restorative therapies.

How can practitioners learn more about these new techniques?
The best way is to attend continuing education events, for example at Dental Bern.